Perineal and rectal tears, anorectal manometry Flashcards
Name two instruments used in delivery
Ventouse (suction)
Forceps
Explain the types of perineal tears
First degree - superficial skin tears
Second degree - perineal muscle tears
Third degree - perineal muscle + anal sphincter tear (can be subclassified)
Fourth degree - perineal muscle + anal sphincter tear + rectal mucosa tear
How can third degree tears be subclassified?
3a= <50 percent external anal sphincter tear
3b = more than 50 percent EAS tear
3c = IAS + EAS tear x
What other type of tear can be sustained besides perineal tears?
Rectal buttonhole tear - where the anal sphincters remain intact but the rectum has a tear
Consequences of rectal buttonhole tears?
Rectovaginal fistula
Risk factors for perineal tears?
Prolonged second stage of labour
Large baby >4kg
Nulliparity
Shoulder dystocia
Instrumental delivery
Apparently also being South Asian
How do you manage a patient with perineal tears?
Surgical repair
Antibiotics
Laxatives
Analgesia
Counsel regarding future deliveries and mode of delivery
Follow up regarding incontinence issues
Prognosis following perineal tears?
60-80 percent of women are asymptomatic a year on from surgical repair of external anal sphincter tears
What’s the acronym for tears?
OASIS - obstetric anal sphincter injuries
What information do you need to know about future pregnancies?
Episiotomy is not needed prophylactically - no evidence of it being useful
Measure anorectal manometry pressure to see if you need an elective c-section
How would you explain anal manometry to a patient?
The anal and rectal area contain special muscles that contract and relax to pass stool. Normally, the muscles contract to keep poo in, and relax to let it out. Sometimes they don’t work properly.
Anal manometry is a type of test used to check how the nerves and muscles of the back passage are working.
It involves placing a small probe, about the size of a thermometer, into your rectum. You will then be asked at various points to squeeze, to push as though going for a poo, and to relax. The probe will measure the pressure from your muscles, and also the sensations picked up by the nerves in your rectum. This will tell us how strong the muscles are working, and whether the nerves are responding properly to the sensation of stool in the back passage.
What does the anorectal manometry do?
Checks anal muscle pressure
Checks sensation
Checks nerve reflexes for normal bowel movements
How long does the anorectal manometry take? Is it painful? What should I do to prepare? What happens afterwards?
Takes 30 mins, not painful
Have fleet enema beforehand (from supermarket)
Eat/drink as normal.
Can go home afterwards
No local anaesthetic needed
See consultant afterwards for review
Who might need anorectal manometry?
Anybody experiencing faecal incontinence, chronic constipation or dyssynergic defaecation
